US MRI Research Articles

Imaging of Kidney Cysts and Cystic Kidney Diseases in Children: An International Working Group Consensus Statement.

Kidney cysts can manifest as focal disease (simple and complex kidney cysts), affect a whole kidney (eg, multicystic dysplastic kidney or cystic dysplasia), or manifest as bilateral cystic disease (eg, autosomal recessive polycystic kidney disease [ARPKD] or autosomal dominant polycystic kidney disease [ADPKD]). In children, as opposed to adults, a larger proportion of kidney cysts are due to genetic diseases (eg, HNF1B nephropathy, various ciliopathies, and tuberous sclerosis complex), and fewer patients have simple cysts or acquired cystic kidney disease. The purpose of this consensus statement is to provide clinical guidance on standardization of imaging tests to evaluate kidney cysts in children. A committee of international experts in pediatric nephrology, pediatric radiology, pediatric US, and adult nephrology prepared systematic literature reviews and formulated recommendations at a consensus meeting. The final statement was endorsed by the European Society of Pediatric Radiology, the European Federation of Societies for Ultrasound in Medicine and Biology, the European Society of Pediatric Nephrology, and reviewed by the European Reference Network for Rare Kidney Diseases. Main recommendations are as follows: US is the method of choice when assessing pediatric kidney cysts, with selected indications for MRI and contrast-enhanced US. CT should be avoided whenever possible because of ionizing radiation. Renal US yields essential diagnostic information in many cases. In patients with ARPKD or other ciliopathies, abdominal US is needed for diagnosis and screening of portal hypertension. US is usually sufficient for follow-up kidney imaging, but MRI can be valuable for clinical trials in patients with ADPKD or in older children with tuberous sclerosis complex to evaluate both kidney cysts and angiomyolipomas.

Liver Imaging Reporting and Data System (LI-RADS) Version 2018: Imaging of Hepatocellular Carcinoma in At-Risk Patients.

The Liver Imaging Reporting and Data System (LI-RADS) is composed of four individual algorithms intended to standardize the lexicon, as well as reporting and care, in patients with or at risk for hepatocellular carcinoma in the context of surveillance with US; diagnosis with CT, MRI, or contrast material-enhanced US; and assessment of treatment response with CT or MRI. This report provides a broad overview of LI-RADS, including its historic development, relationship to other imaging guidelines, composition, aims, and future directions. In addition, readers will understand the motivation for and key components of the 2018 update.

Villous Gastrointestinal Tumors: Multimodality Imaging with Histopathologic Correlation.

Villous lesions are advanced adenomas that manifest most commonly in the colon; however, they can develop throughout the gastrointestinal tract. The duodenum is the most common small-bowel site of these lesions. Although in most cases these are isolated lesions that occur sporadically, patients with certain specific colorectal cancer syndromes, including familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer, may develop multiple advanced adenomas. Villous lesions are important because although they are histologically benign, they may harbor dysplasia and have potential for malignancy. These characteristics make them a primary target for colorectal cancer screening with optical and virtual colonoscopy. However, these lesions can also be symptomatic and detected at diagnostic imaging when patients present for examination. They have characteristic features at a variety of imaging examinations, including barium fluoroscopy, CT, MRI, and endoscopic US. It is important for radiologists to be aware of these lesions, their potential morphologies, and their typical appearances at multimodality imaging. Although villous tumors can be detected at imaging and confirmed with biopsy, owing to limitations in identifying dysplasia and foci of malignancy with the above modalities alone and the potential for malignancy, referral for surgical resection of these lesions ultimately is required. ©RSNA, 2018.

E56 Study of disease severity scale, carotid US features and MRI brain in systemic sclerosis

e56 Study of disease severity scale, carotid US features and MRI brain in systemic sclerosis

3:54 PM Abstract No. 187 Renal cell carcinoma local recurrence vs. non-malignant imaging mimics post-radiofrequency ablation: incidence, imaging features, and natural history

To compare the frequency, imaging characteristics and natural history of non-malignant imaging mimics of tumor recurrence following successful radiofrequency ablation (RFA) of RCC with confirmed local recurrence. A single-center, retrospective case-control study evaluated all patients with successful RFA treatment of biopsy-confirmed RCC or suspicious oncocytic neoplasm between April 2004 and June 2016. Inclusion criteria included minimum post-RFA follow-up of 10 months and at least 2 contrast-enhanced studies post-RFA. 256 patients and 268 tumors were included (mean follow-up 4.2 ± 2.6 years). All RFA procedures were performed under conscious sedation using a multi-tined RF electrode. Post-RFA imaging follow-up was with either multiphase CT, MRI or contrast-enhanced US. All patients flagged by the radiologist as suspicious for local recurrence were analyzed and stratified into 1) Local recurrence (LR) or 2) Non-malignant changes (NMC). Patients were categorized as NMC only if a biopsy confirmed no viable tumor or if the abnormal features resolved on follow-up imaging. Local recurrence and non-malignant changes occurred in 3.4% (9/268) and 2.6% (7/268) of all treated tumors. Mean age at time of RFA (LR 64.7 ± 14.1, NMC 69.9 ± 8.5 years), tumor size (LR 2.9 ± 0.8, NMC 2.4 ± 0.4 cm), and time post-RFA to imaging abnormality detection (LR 29.0 ± 19.5, NMC 40.3 ± 17.7 months) were not significantly different between the groups. Respective tumor histologies were LR: clear cell 8 (89%); papillary 1 (11%) and NMC: clear cell 4 (57%); papillary, chromophobe & oncocytic neoplasm 1 each (14%). Imaging characteristics differed between the two groups as the amount of CT enhancement above the precontrast baseline was significantly higher (p<0.001) for the LR group (155 ± 38 HU) than the NMC group (28 ± 8 HU). Post-ablation nodular enhancement either centrally within the region of coagulation or along the extra-renal ablation margin was more commonly associated with NMC (4/5 tumors), while nodular enhancement along the renal parenchyma margin was always LR (8/8 tumors). Non-malignant changes post-RFA can mimic RCC recurrence on imaging and should be recognized to minimize unnecessary treatment.

A novel planning solution for semi-autonomous aspiration of Baker's cysts.

A Baker's cyst is a pathological structure located near a kneepit, which causes discomfort and reduces mobility of the knee. It is commonly treated with aspiration, which often requires MRI scanning and US guidance. The aim of this study was to propose a novel planning solution for semi-autonomous aspiration of the Baker's cyst using only MRI imaging. The proposed method requires minimal user input and offers automatic cyst segmentation with collision-free path planning for the assumed robotic structure with four degrees of freedom. The prepared software was tested on four image sets obtained from patients eligible for cyst aspiration. It was possible to accurately segment the cyst in the considered cases. The collision-free path planning method was investigated in numerical scenarios. The simulations verified the proposed software solution. Future work will be devoted to experimental verification of the path planning procedure.

Hybrid Technology Fusion MRI/US and Sonoelastography in Diagnosis of Fatty Degeneration and Atrophy of Supraspinatus Muscle of the Shoulder

Evaluation of the rotator cuff muscles is of value for surgical indications and successful postoperative prognosis. Ultrasound is widely used for detection of rotator cuff tears, but it’s role in evaluation of the rotator cuff muscles is not yet defined. A new method Fusion MRI/US with elastography is able to show differences in tissue stiffness, and a simultaneous combination of two methods helps to overcome limitations from US – narrow field of view, and from MRI – impossibility for real time examination and low space resolution.Purpose.To investigate diagnostic performance and interobserver reliability of US elastography and to study possibilities of Fusion MRI/US technique in grading fatty degeneration and atrophy of the supraspinatus muscle.Materials and methods.72 patients from 128 with shoulder pain and disability with written diagnostic confirm were specially selected for the study with US elastography and MRI and 29 patients were enrolled for Fusion MRI/US study. Oblique sagittal scans through the supraspinatus muscle were performed during US elastography study in the standard manner for comparance with MRI. The amount of fatty degeneration was graded according to the modified Goutallier five-point scale, with use of a 3-point scale – with US elastography. US results for grade of atrophy and fatty degeneration were retrospectively reviewed by 2 blinded to each other results experts. Sensitivity and interobserver reliability was estimated.Results.The sensitivity of standard US in comparance to US elastography in assessment of muscle atrophy with the reference to MRI was 53% and 76%, respectively. The sensitivity of US and US elastography increased with increasing of the grade of muscle atrophy. The sensitivity of US and US elastography in detection of fatty degeneration was slightly better 65% and 85%, respectively. US elastography were more sensitive in evaluation of fatty degeneration in full thickness than in partial thickness rotator cuff tears. In all cases of full thickness tears US with elastography had a 100% sensitivity in assessment of atrophy and fatty degeneration in the reference to MRI. While in partial tears the sensitivity decreased to 66%. The agreement between MRI and US elastography for the grade of fatty degeneration of the supraspinatus was substantial (kappa = 0.78). The interobserver reliability for US was fair (kappa = 0.41), and for US elastography substantial (kappa=0,71).Conclusion. Sonoelastography helps to increase the diagnostic performance of US in identifying and grading fatty degeneration and atrophy of the supraspinatus. US with elastography can be used as a primary modality for fatty changes and atrophy of the supraspinatus.

Sonographic diagnosis and prognosis of fetal arachnoid cysts

To explore the clinical significance of sonographic (US) diagnosis of fetal arachnoid cysts and to evaluate their prognosis. Sixty fetuses deemed to have arachnoid cysts by prenatal US were included in this study. Data from serial US, prenatal and/or postnatal MRI, or post-mortem examinations were retrospectively analyzed. For live births, the developmental quotient scores were determined using the Gesell Developmental Scale. Thirty fetuses were diagnosed during the second trimester and another 30 fetuses were diagnosed in the third trimester. Fifty-one lesions were located in the supratentorial compartment, and 9 were located in the posterior fossa. Twenty-four lesions were isolated, and the remaining lesions were associated with intracranial and/or extra central nervous system malformations. The evolution of the cysts included progression, stability, or spontaneous resolution. The outcomes included induced abortion, intrauterine death, live birth with either normal neurodevelopment or mental retardation, and infant mortality. Two cases were lost to follow-up. The accuracy of prenatal US diagnosis was 86.2% (50/58). Prenatal US is the modality of choice for the diagnosis of fetal arachnoid cysts. Serial US examinations are critical to monitor the lesions. Moreover, prenatal MRI is a valuable complementary tool. For live births, the prognosis appears to be good.

Fetal and Postnatal Brain Imaging for the Detection of ZIKV Encephalopathy in the Fetus/Newborn

BackgroundUp to 15% of pregnancies complicated by maternal ZIKV infection result in Zika-virus associated brain abnormalities in the fetus/newborn. Fetal ultrasound (feUS) is the standard imaging modality for the evaluation of fetal anatomy and for brain changes from congenital infection. Fetal MRI (feMRI) may be a useful adjunct.MethodsWe performed a prospective longitudinal neuroimaging study of fetuses/newborns of pregnant women with clinical and/or lab confirmed (RT-PCR and/or IgM/PRNT) diagnosis of Zika infection in Barranquilla, Colombia (endemic) and in Washington, DC, USA (travel-related). Gestational age (GA) at exposure and timing between ZIKV exposure/symptoms and imaging was documented. Subjects had one to two feMRIs and feUS, depending upon GA at enrollment. The feMRI and feUS protocols were standardized between sites and studies were centrally interpreted at Children’s National. Postnatally, infants received an unsedated brain MRI and head US.ResultsForty-eight, ZIKV exposed/infected in first or second trimester pregnant women were enrolled (46 Colombia, 2 USA). Subjects had symptoms of ZIKV infection at mean of 8.4±5.7 week GA. The first feMRI and feUS were performed at 25.1±6.3 week GA. Thirty-six infants had a second feMRI and feUS at 31.1±4.2 week GA. Three of 48 (6%) cases had an abnormal feMRI: (1) heterotopias and abnormal cortical indent; (2) parietal encephalocele and Chiari II; (3) thin corpus callosum, dysplastic brainstem, temporal cysts, subependymal heterotopias, and generalized cerebral/cerebellar atrophy. FeUS in these three cases found (1) normal study; (2) parietal encephalocele and Chiari II; (3) significant ventriculomegaly with decreasing percentiles of head circumference from 32 to 36 week GA (38% to 3.6%). Postnatal head US revealed findings not seen on feUS: choroid plexus or germinal matrix cysts in nine infants and lenticulostriate vasculopathy in one infant.ConclusionFeMRI and feUS provide complimentary information in the assessment of fetal brain changes in ZIKV. In cases of abnormal brain structure, feMRI reveals more extensive areas of brain damage than is seen by US. Further studies are needed to determine whether cystic changes on postnatal head US are related to ZIKV infection, or are incidental findings.Disclosures All authors: No reported disclosures.

Multimodal image registration based on binary gradient angle descriptor.

Multimodal image registration plays an important role in image-guided interventions/therapy and atlas building, and it is still a challenging task due to the complex intensity variations in different modalities. The paper addresses the problem and proposes a simple, compact, fast and generally applicable modality-independent binary gradient angle descriptor (BGA) based on the rationale of gradient orientation alignment. The BGA can be easily calculated at each voxel by coding the quadrant in which a local gradient vector falls, and it has an extremely low computational complexity, requiring only three convolutions, two multiplication operations and two comparison operations. Meanwhile, the binarized encoding of the gradient orientation makes the BGA more resistant to image degradations compared with conventional gradient orientation methods. The BGA can extract similar feature descriptors for different modalities and enable the use of simple similarity measures, which makes it applicable within a wide range of optimization frameworks. The results for pairwise multimodal and monomodal registrations between various images (T1, T2, PD, T1c, Flair) consistently show that the BGA significantly outperforms localized mutual information. The experimental results also confirm that the BGA can be a reliable alternative to the sum of absolute difference in monomodal image registration. The BGA can also achieve an accuracy of [Formula: see text], similar to that of the SSC, for the deformable registration of inhale and exhale CT scans. Specifically, for the highly challenging deformable registration of preoperative MRI and 3D intraoperative ultrasound images, the BGA achieves a similar registration accuracy of [Formula: see text] compared with state-of-the-art approaches, with a computation time of 18.3s per case. The BGA improves the registration performance in terms of both accuracy and time efficiency. With further acceleration, the framework has the potential for application in time-sensitive clinical environments, such as for preoperative MRI and intraoperative US image registration for image-guided intervention.

Imaging of thoracic tuberculosis in children: current and future directions.

Tuberculosis continues to be an important cause of morbidity and mortality worldwide. It is the leading cause of infection-related deaths worldwide. Children are amongst the high-risk groups for developing tuberculosis and often pose a challenge to the clinicians in making a definitive diagnosis. The newly released global tuberculosis report from World Health Organization reveals a 50% increase in fatality from tuberculosis in children. Significantly, diagnostic and treatment algorithms of tuberculosis for children differ from those of adults. Bacteriologic confirmation of the disease is often difficult in children; hence radiologists have an important role to play in early diagnosis of this disease. Despite advancing technology, the key diagnostic imaging modalities for primary care and emergency services, especially in rural and low-resource areas, are chest radiography and ultrasonography. In this article, we discuss various diagnostic imaging modalities used in diagnosis and treatment of tuberculosis and their indications. We highlight the use of US as point-of-care service along with mediastinal US and rapid MRI protocols, especially in mediastinal lymphadenopathy and thoracic complications. MRI is the ideal modality in high-resource areas when adequate infrastructure is available. Because the prevalence of tuberculosis is highest in lower-resource countries, we also discuss global initiatives in low-resource settings.

A prospective non-randomized controlled, multicenter trial comparing Appendectomy and Conservative Treatment for Patients with Uncomplicated Acute Appendicitis (the ACTUAA study)

Acute appendicitis (AA) is among the most common causes of lower abdominal pain and admissions to the emergency department. Over the past 20years, there has been a renewed interest in the conservative management of uncomplicated AA, and several studies demonstrated that an antibiotic-first strategy is a viable treatment option for uncomplicated AA. The aim of this prospective non-randomized controlled, multicenter trial is to compare antibiotic therapy and emergency appendectomy as treatment for patients with uncomplicated AA confirmed by US and/or CT or MRI scan. All adult patients in the age range 18 to 65years with suspected AA, consecutively admitted to the Surgical Department of the 13 participating Italian Hospitals, will be invited to take part in the study. A multicenter prospective collected registry developed by surgeons, radiologists, and pathologists with expertise in the diagnosis and treatment of uncomplicated acute appendicitis represents the best research method to assess the long-term role of antibiotics in the management of the disease. Comparison will be made between surgical and antibiotic-first approaches to uncomplicated AA through the analysis of the primary outcome measure of complication-free treatment success rate based on 1-year follow-up. Quality of life, length of hospital stay, pain evaluation, and time to return to normal activity will be evaluated as secondary outcome measures. Clinicaltrials.gov ID: NCT03080103.

Contrast-enhanced US with Perfluorobutane(Sonazoid) used as a surveillance test for Hepatocellular Carcinoma (HCC) in Cirrhosis (SCAN): an exploratory cross-sectional study for a diagnostic trial

BackgroundUltrasonography (US) is widely used as a standard surveillance tool for patients who are at a high risk of having hepatocellular carcinoma (HCC); however, conventional B-mode US appears to be insufficient in order to ensure the early detection of HCC. Perfluorobutane allows very stable Kupffer phase imaging for at least 60 min, which is tolerable for examinations of the entire liver. The purpose of our study is to evaluate the added value of contrast-enhanced US using perfluorobutane to that of conventional B-mode US as an HCC surveillance tool for patients with liver cirrhosis.Methods/DesignSCAN (Sonazoid-US for surveillance of hepatoCellulArcarciNoma) is a prospective, multi-institutional, diagnostic trial using an intra-individual comparison design in a single arm of patients. This study was approved by our five institutional review board and informed consent was obtained from all participating. We obtained consent for publication of these data (contrast enhanced US images, CT or MRI images, laboratory findings, age, sex) from all participating patients. All patients will undergo conventional B-mode US immediately followed by contrast-enhanced US. The standardized case report forms will be completed by operating radiologists after B-mode US and contrast-enhanced US, respectively. If any lesion(s) is detected, the likelihood of HCC will be recorded. The primary endpoints are a detection rate of early-stage HCC and a false referral rate of HCC. Intra-individual comparison using Mcnemar’s test will be performed between B-mode US and contrast-enhanced US. The study will include 523 patients under HCC surveillance in five medical institutions in Korea.DiscussionSCAN is the first study to investigate the efficacy of contrast-enhanced US in surveillance using two reciprocal endpoints specialized for the evaluation of a surveillance test. SCAN will provide evidence regarding whether patients can truly benefit from contrast-enhanced US in terms of the detection of early stage HCC while avoiding additional unnecessary examinations. In addition to the study protocol, we elaborate on potentially debatable components of SCAN, including the design of an intra-individual comparison study, study endpoints, composite reference standards, and indefinite imaging criteria regarding the likelihood of HCC.Trial registrationThe date of trial registration (ClincalTrials.gov: NCT02188901) in this study is July 3, 2014. The last patient enrolled in August 30, 2016 and follow up to see the primary end point is still ongoing. All authors have no other relationships/conditions/circumstances that present a potential conflict of interest of relationships. Our study protocol has undergone peer-review by the funding body (GE Healthcare). No other relationships/conditions/circumstances that present a potential conflict of interest. Also, we clearly stated in the 'competing interests' section of my manuscript.

Hough-CNN: Deep learning for segmentation of deep brain regions in MRI and ultrasound

In this work we propose a novel approach to perform segmentation by leveraging the abstraction capabilities of convolutional neural networks (CNNs). Our method is based on Hough voting, a strategy that allows for fully automatic localisation and segmentation of the anatomies of interest. This approach does not only use the CNN classification outcomes, but it also implements voting by exploiting the features produced by the deepest portion of the network. We show that this learning-based segmentation method is robust, multi-region, flexible and can be easily adapted to different modalities. In the attempt to show the capabilities and the behaviour of CNNs when they are applied to medical image analysis, we perform a systematic study of the performances of six different network architectures, conceived according to state-of-the-art criteria, in various situations. We evaluate the impact of both different amount of training data and different data dimensionality (2D, 2.5D and 3D) on the final results. We show results on both MRI and transcranial US volumes depicting respectively 26 regions of the basal ganglia and the midbrain.

Comparison of Ultrasound and MR Imaging of Non-Calcified Ductal Carcinoma in Situ with Pathologic Correlation

To illustrate the imaging features of non-calcified ductal carcinoma in situ (DCIS) on ultrasonography and breast MR imaging and to determine the role the imaging studies in the diagnosis and treatment decision of non-calcified DCIS. Radiologic images and clinical histories of 34 patients with histologically verified non calcified ductal carcinoma in situ (DCIS) were retrospectively studied. All patients were female and between the ages of 27 and 73 years (mean age, 47.6 years). Mammography (n=34), Breast US (n=34), and Breast MR imaging (n=29) were performed. The diagnosis of DCIS of the breast was pathologically confirmed by means of examination of the specimens obtained at surgical biopsy. We correlated radiologic findings with pathologic results. All patients were female and between the ages of 27 and 73 years(mean age, 47.6 years). The mean size was 1.7cm. DCIS is a heterogeneous disease comprising a spectrum of noninvasive malignant tumors of the breast. In the 34 patients who underwent ultrasound, 32 patients presented with abnormal findings: mass(63%), intraductal echogenic lesion(18%), irregular ductal wall thickening or nodularity(15%) and mixed pattern(4%). In the 29 patients who had received breast MRI, a mass was present in 22 patients and irregular ductal enhancement in 7 patients. Diagnosis of non-calcified DCIS by mammography is challenging. Thus, high resolution US and breast MRI can be essential to decide accurate diagnosis. Comprehensive knowledge of US and MRI findings of non-calcified DCIS of the breast can help early detection and improve prognosis.

Mistakes in the diagnosis of children intraocular tumors

SummaryThe first mistake is to consider normal a unilateral strabismus or a leucocoria in a baby or a child and don't performed a dilated funduscopy. Retinoblastoma is the first ocular tumor in childhood and often late diagnosed because professionals (pediatrician, GPs, or ophthalmologists) didn't believe parents that notice a white reflect in their kid's pupil. Clinically, on dilated fundus, one or more white tumors can be associated with exudative retinal detachment or subretinal or vitreal seedings. The disease can be unilateral or bilateral. Several forms can be more difficult to diagnosed (infiltrative retinoblastoma, inflammatory cellulitis associated with advanced retinoblastoma, neovascular glaucoma with buphtalmia associated with advanced retinoblastoma. The more frequent disorder that can stimulate retinoblastoma is coats disease especially in advanced forms, persistent hyperplastic primary vitreous, and other rare tumors (medulloepitheloima, leiomyoma or melanoma). The proper diagnosis can be done in referral centers with team trained to deal with these diseases and sometime with the help of US echography or MRI of the eye. In case of suspicion of ocular tumor, the child must be referred in emergency in a specialized center.

Uterine artery pulsatility and resistivity indices in pregnancy: Comparison of MRI and Doppler US

ObjectiveThe aim of this work was to evaluate whether the uterine arteries (UtA) could be identified and their flow profiles measured during a fetal MRI examination. A comparison was performed against same day sonographic Doppler assessment. Methods35 normal, healthy, singleton pregnancies at 28–32 weeks gestation underwent routine Doppler examination, followed by MRI examination. The resistivity index (RI) and pulsatility index (PI) of the left and right UtA were measured using phase contrast MRI. Bland Altman statistics were used to compare MRI and ultrasound results. ResultsSixty-nine comparable vessels were analysed. Six vessels were excluded due to artefact or technical error. Bland-Altman analysis demonstrated the ultrasound indices were comparable, although systematically lower than the MRI indices; Right UtA RI bias −0.03 (95% limits of agreement (LOA) −0.27 to +0.20), and left UtA RI bias −0.06 (95% LOA −0.26 to +0.14); Right UtA PI bias −0.06 (95% LOA −0.50 to +0.38), Left UtA PI bias −0.11 (95% LOA −0.54 to +0.32). The inter-rater agreement for the MRI derived PI and RI analysis was good. ConclusionThis study demonstrates that in the majority of early third trimester pregnancies, the uterine arteries can be identified, and their flow profiles measured using MRI, and that the derived PI and RI values are comparable with Doppler ultrasound values.

Spontaneous Regression of Colorectal Liver Metastases

Spontaneous regression of cancer is a rare phenomenon, often of obscure etiology. We present the case of a 51-year-old female patient, whose colorectal liver metastases, diagnosed by CT scan and confirmed by MRI and per-operative US scan, underwent spontaneous necrosis, as demonstrated by pathological examination. She was submitted to left colectomy, splenectomy and total hysterectomy six years earlier followed by adjuvant chemotherapy, as treatment of the primary tumour (adenocarcinoma of the splenic angle of the colon, staged as pT3,N1,M0). She underwent a right hepatectomy to treat liver metastases, located in the segments VIII and V/VI of the liver; to date, she remains asymptomatic and disease-free. We hope this case may contribute to the characterization of a subset of patients whose malignancy spontaneously regresses, which may prove decisive in the development of new strategies for cancer treatment.

Fetal suprarenal masses--assessing the complementary role of magnetic resonance and ultrasound for diagnosis.

To assess the value and complementary roles of fetal MRI and US for characterization and diagnosis of suprarenal masses. We conducted a multi-institutional retrospective database search for prenatally diagnosed suprarenal masses between 1999 and 2012 and evaluated the roles of prenatal US and fetal MRI for characterization and diagnosis, using postnatal diagnosis or surgical pathology as the reference standard. Prenatal US and fetal MRI were assessed for unique findings of each modality. The database yielded 25 fetuses (gestational age 20-37weeks) with suprarenal masses. Twenty-one fetuses had prenatal US, 22 had MRI, 17 had both. Postnatal diagnoses included nine subdiaphragmatic extralobar sequestrations, seven adrenal hemorrhages, five neuroblastomas (four metastatic), two lymphatic malformations, one duplex kidney with upper pole cystic dysplasia, and one adrenal hyperplasia. Ultrasound was concordant with MRI for diagnoses in 12/17 (70.6%) cases. Discordant diagnoses between US and MRI included three neuroblastomas and two adrenal hemorrhages. In the three neuroblastomas US was equivocal and MRI was definitive for neuroblastoma, demonstrating heterogeneous, intermediate-signal solid masses and liver metastases. In the two cases of adrenal hemorrhage US was equivocal and MRI was definitive with signal characteristics of hemorrhage. In 2/4 neuroblastomas, Doppler US demonstrated a systemic artery suggesting extralobar sequestration; however MRI signal characteristics correctly diagnosed neuroblastoma. All cases of extralobar sequestration were correctly diagnosed by US and MRI. US and MRI both accurately detect suprarenal masses. MRI complements US in equivocal diagnoses and detects additional findings such as liver metastases in neuroblastoma.

Feasibility and safety of conservative surgery for the treatment of spermatic cord leiomyosarcoma

ObjectivesTo assess the feasibility and the safety of conservative surgery to treat spermatic cord leiomyosarcoma. MethodsPatients undergoing inguinoscrotal exploration in 10 different Urological Centers with diagnosis of leiomyosarcoma were enrolled. Preoperative evaluation included physical examination, Scrotal US, Abdominal CT and Scrotal MRI in selected cases. Patients underwent organ sparing surgery or orchiectomy in case of intraoperative FSE was positive for a local infiltration. Data collected were: age, presence of infiltration, length of the lesion, number of lesions, definitive histological outcome, pre and postoperative testosterone level. Follow up was performed with abdomen CT scan and scrotal US. ResultsFrom January 2007 to December 2013, 23 patients (mean age: 64.7 yrs) were diagnosed with spermatic cord leiomyosarcoma. Each patients underwent scrotal US. 10 patients underwent radical orchiectomy and 13 patients underwent conservative surgery. Mean follow up was 36.5 months. 5 patients (21.7%) developed a recurrent disease, 18 patients (78.3%) had a negative follow up (mean time: 40.8 months). Statistical analysis reveals that there is a significant correlation between number of lesions, length of the lesions and recurrent disease. ConclusionsSpermatic cord leiomyosarcoma is a rare disease. Conservative surgical treatment of spermatic cord leiomyosarcoma is a feasible therapeutic option for small, single and not infiltrating lesion.